Riesgo de accidentes biológicos en estudiantes de la salud: revisión de la literatura en los últimos 14 años.

Introducción: Todos los trabajadores del área de la salud están en riesgo de padecer un accidente biológico. No obstante los estudiantes de estas aéreas, pueden presentar más riesgo porque apenas están en formación y no tienen la práctica o experiencia suficiente. Existen varios artículos que han estudiado la incidencia y prevalencia de accidentes biológicos en los trabajadores del área de la salud, Sin embargo, sobre esta problemática de la población estudiantil del área de la salud, se encuentra menos literatura. Por lo tanto con esta revisión sistemática se busca analizar y actualizar este tema. Métodos: Se realizó una revisión de la literatura científica de artículos publicados en los últimos 14 años, en relación con la prevalencia de accidentes biológicos en estudiantes de medicina, odontología, enfermería y residentes del área de la salud a nivel mundial. Se llevó a cabo la búsqueda en la base de datos de Pubmed, encontrando un total de 100 artículos, escritos en inglés, francés, español o portugués. Resultados: Las prevalencias encontradas sobre accidentes biológicos en estudiantes fueron las siguientes: en países europeos a nivel de enfermería los valores oscilan entre 10.2 % a 32%, en medicina fueron del 16%-58.8%, y en odontología del 21 %. En países asiáticos, se encontró que en enfermería el porcentaje varía de 49%-96 %, en medicina van del 35% -68%, y en odontología varia de 68.a 75.4%. En Norte América, en medicina las cifras fluctúan alrededor del 11-72.7 % y en odontología giran alrededor del 19.1%. Finalmente respecto a Suramérica la prevalencia fue de 31.2 a 46.7% en medicina, y del 40% en enfermería. Conclusiones: Por lo anterior se pudo concluir que, la prevalencia de accidentes biológicos en los estudiantes del área de la salud es elevada y varía según el continente en el que se encuentren.

Resultados de la cirugía laparoscópica comparada con la cirugía abierta en el cáncer colorrectal. Revisión sistemática

Determinar el efecto de la cirugía laparoscópica versus cirugía abierta sobre la supervivencia en el manejo de pacientes del cáncer colorectal.

The application of implant technology for cybernetic systems

Objective: To assess the usefulness, compatibility, and long-term operability of a microelectrode array into the median nerve of the left arm of a healthy volunteer, including perception of feedback stimulation and operation of an instrumented prosthetic hand. Setting: The study was carried out from March 14 through June 18, 2002, in England and the United States. Results: The blindfolded subject received feedback information, obtained from force and slip sensors on the prosthetic hand, and subsequently used the implanted device to control the hand by applying an appropriate force to g rip an unseen object. Operability was also demonstrated remotely via the Internet, with the subject in New York, NY, and the prosthetic hand in Reading, England. Finally, the subject was able to control an electric wheelchair, via decoded signals from the implant device, to select the direction of travel by opening and closing his hand. The implantation did not result in infection or any perceivable loss of hand sensation or motion control. The implant was finally extracted because of mechanical fatigue of the percutaneous connection. Further testing after extraction has not indicated any measurable long-term defects in the subject. Conclusions: This implant may allow recipients to have abilities they would otherwise not possess. The response to stimulation improved considerably during the trial, suggesting that the subject learned to process the incoming information more effectively.

Intracellular or intercellular localization of the polar pathway of penetration across stratum corneum

A pharmacokinetic hypothesis of stratum corneum with two parallel pathways, lipophilic and porous hydrophilic, is not well documented yet. Still questionable is the localization of the pores, and the present experiments were designed to elucidate the contribution of extracellular lipids and intracellular keratin to the structure of this pathway. Percutaneous penetration of baclofen, a model zwitterion, was studied in vitro using human cadaver skin. Aqueous or ethanolic saturated solutions of the drug (Cs = 4.6 and 0.4 mg/ mL, respectively) were applied on the skin that was pretreated with: methanol/chloroform (Me/Ch) or acetone-chloroform (Ac/Ch) (1:1) mixtures, or with these solvents followed by 0.2% solution of sodium lauryl sulfate (SLS). As controls, baclofen penetration through the intact full-thickness skin was determined, and the fluxes were 0.18 ±0.08 and 0.14 ±0.07 µg/cm2/h for aqueous and ethanolic solutions, respectively. When Me/Ch was used for 1 h, an expected increase of the penetration was observed, but the lag time, Tlag, was still nearly 20 h. When the less polar mixture, Ac/Ch, was used, no flux enhancement was observed, and with ethanol as the vehicle, decreased penetration was even noted. No effect on baclofen penetration was observed when SLS was used for 1 h after delipidization of the skin was done with either the Me/Ch or Ac/Ch mixture. The results suggest that the polar pathway may be located intercellularly and comprises aqueous regions surrounded by polar lipids, which create the walls of such microchannels.

Enterobacter sakazakii bacteraemia with multiple splenic abscesses in a 75-year-old woman: a case report.

Enterobacter sakazakii is an uncommon bacterium that is known to cause severe neonatal infection and is rare among adults. We present a peculiar case of E. sakazakii bacteraemia with multiple splenic abscesses in a 75-year-old institutionalised woman, who was successfully treated with 6 weeks of imipenem and percutaneous drainage of the abscesses.

Single-use Trocar Is it Possible to Reprocess it After the First Use?

The aim of this study was to verify and describe the presence of microorganisms in the single-use trocar after its use in surgical procedures, and after this device was submitted to cleaning, conditioning, and sterilization by physicochemical processes (formaldehyde, ethylene oxide, and hydrogen peroxide plasma). Twenty-eight trocars of the Ethicon, Auto-suture, and Aesculap brands, were randomly selected and analyzed after laparoscopic cholecystectomy. The results have shown that cultures grown of the material collected from the trocars, immediately after its use and before its sterilization process, showed the presence of bacteria and fungi in 46.5% (13). In 53.5% (15) of the trocars, the presence of microorganisms was not detected, very likely due to niche`s scarcity. In the cultures grown of the 28 trocars after being submitted to sterilization processes, the presence of microorganisms was not verified. We can therefore conclude that although trocars possess compartments not easily accessed for cleaning, these devices can be adequately cleaned and effectively sterilized, when well manipulated, in the institution where the study was carried out by the processes of steam sterilization at low temperature and formaldehyde, ethylene oxide, and hydrogen peroxide plasma.

Inhibitory activity of limonene against Leishmania parasites in vitro and in vivo

Limonene is a monoterpene that has antitumoral, antibiotic and antiprotozoal activity. In this study we demonstrate the activity of limonene against Leishmania species in vitro and in vivo. Limonene killed Leishmania amazonensis promastigotes and amastigotes with 50% inhibitory concentrations of 252.0 +/- 49.0 and 147.0 +/- 46.0 mu M, respectively. Limonene was also effective against Leishmania major, Leishmania braziliensis and Leishmania chagasi promastigotes. The treatment of L. amazonensis-infected macrophages with 300 mu M limonene resulted in 78% reduction in infection rates. L. amazonensis-infected mice treated topically or intrarectally with limonene had significant reduction of lesion sizes. A significant decrease in the parasite load was shown in the lesions treated topically with limonene by histopathological examination. The intrarectal treatment was highly effective in decreasing the parasite burden, healing established lesions and suppressing the dissemination of ulcers. Limonene presents low toxicity in humans and has been shown to be effective as an agent for enhancing the percutaneous permeation of drugs. Our results suggest that limonene should be tested in different experimental models of infection by Leishmania. (C) 2009 Elsevier Masson SAS. All rights reserved.

Mechanism of Muscle Vibrations During Stimulated and Voluntary Isometric Contractions of Mammalian Skeletal Muscle

When a muscle contracts it produces vibrations. The origin of these vibrations is not known in detail. The purpose of this study was to determine the mechanism associated with muscle vibrations. Mechanisms which have been proposed in the literature were described as theories (cross-bridge cycling, vibrating string and unfused motor unit theories). Specific predictions were derived from each theory, and tested in three conceptually different studies. In the first study, the influence of recruitment strategies of motor units (MUs) on the vibromyographic (VMG) signal was studied in the in-situ cat soleus using electrical stimulation of the soleus nerve. VMG signals increased with increasing recruitment and decreased with increasing firing rates of MUs. Similar results were obtained for the human rectus femoris (RF) muscle using percutaneous electrical stimulation of the femoral nerve. The influence of MU activation on muscle vibrations was studied in RF by analyzing VMG signals at different percentages (0-100%) of the maximal voluntary contraction (MVC). In our second study, we tested the effects of changing the material properties of the in-situ cat soleus (through muscle length changes) on the VMG signal. The magnitude of the VMG signal was higher for intermediate muscle lengths compared to the longest and the shortest muscle lengths. The decreased magnitude of the VMG signal at the longest and at the shortest muscle lengths was associated with increased passive stiffness and with decreased force transients during unfused contractions, respectively. In the third study, the effect of fatigue on muscle vibrations was studied in human RF and vastus lateralis (VL) musc1es during isometric voluntary contractions at a leveI of 70% MVC. A decrease in the VMG signal magnitude was observed in RF (presumably due to derecruitment of MUs) and an increase in VL (probably related to the enhancement of physiological tremor, which may have occurred predorninantly in a mediolateral direction) with fatigue. The unfused MU theory, which is based on the idea that force transients produced by MUs during unfused tetanic contraction is the mechanism for muscle vibrations, was supported by the results obtained in the above three studies.

Implante endoscópico no esôfago distal de polimetilmetacrilato para controle do refluxo gastrofágico : estudo experimental em modelo animal

XIXA doença do refluxo gastroesofágico (DRGE) comumente afeta o esôfago e provavelmente é a condição mais prevalente no segmento alto do trato gastrointestinal, acometendo entre 5 e 45% da população ocidental. A terapêutica atual para essa doença além de medidas gerais e dietéticas, inclui tratamento farmacológico e/ou cirurgia. Ambos podem ser eficazes, mas apresentam elevado custo financeiro. O tratamento com fármacos pode apresentar baixa aderência medicamentosa e a cirurgia tem baixa, mas não desprezível, morbidade e mortalidade. Idealmente o tratamento da DRGE deveria ser eficaz, com baixo risco e com baixo custo. Objetivos: 1. Desenvolver um modelo experimental em suínos para o estudo do Refluxo Gastroesofágico através da Pressão e do Volume de Vazão Gástricos; 2. Avaliar a eficácia do implante endoscópico de PMMA ao nível do Esfíncter Esofágico Inferior (EEI) para aumentar a Pressão de Vazão Gástrica, o Volume de Vazão Gástrico e a Pressão Basal do EEI; 3. Descrever as reações histológicas associadas ao implante de PMMA. Material e Métodos: Suínos da raça Large White, do sexo feminino com 8 semanas de vida foram estudados no experimento. Foi realizada manometria do esfíncter esofágico inferior com registro da pressão basal com cateter de perfusão com água e técnica de retirada lenta. Calculou-se, também, a extensão do EEI. Após, gastrostomia era realizada com colocação intragástrica da extremidade distal de uma sonda de Foley com três vias e um cateter de pHmetria esofágica introduzido via oral com o sensor distal posicionado 5 cm acima do bordo superior de esfíncter esofágico inferior. Iniciava-se, XXentão, a infusão contínua no estômago de uma solução de HCl a 0,02N com medida e registro simultâneos da Pressão e do Volume de Vazão Gástricos e do pH esofágico. Definiu-se a Pressão de Vazão Gástrica (PVG) e o Volume de Vazão Gástrico quando houve brusca e sustentada acidificação do esôfago distal (pH<3). Após, introduzia-se um tubo metálico (Tubo Introdutor ou TI) via oral e, em seguida, o endoscópio, seguindo ambos até o esôfago distal. Cateter de nylon com agulha calibre 16 era introduzido pelo tubo introdutor e o PMMA implantado na área correspondente ao EEI com uma pistola dosadora volumétrica que permitia a injeção de volumes prédeterminados em 3 ou 4 pontos da submucosa (total por ponto = 0,73 ml de PMMA). As medidas de PVG, VVG e pressão basal do EEI foram repetidas após 28 dias, sacrificando-se os animais e removendo-se esôfago médio e distal, junção esofagogástrica, fundo e corpo gástricos para estudo histológico. Previamente ao experimento, três projetos pilotos foram desenvolvidos. O primeiro designado como “Projeto Piloto: Refluxo Gastroesofágico por pHmetria de 24H” (RGE 24H) buscou a via de acesso transnasal para registro de pHmetria por 24 horas. No segundo, designado “Projeto Piloto: Esofagostomia”, para confirmação de refluxo gastroesofágico espontâneo em suínos da raça Large White, utilizou-se anestesia com associação de tiletamina 125 mg e zolazepam 125 mg em combinação com um sedativo, a xilazina a 2% . A pHmetria foi mantida por 24 horas. Os dados descritos por Kadirkamanathan et al. não foram reproduzidos no nosso laboratório. Optou-se então pela realização de um terceiro projeto, “Projeto Piloto: Gastrostomia” para induzir refluxo gastroesofágico através de um modelo experimental e testar a reprodutibilidade da Pressão de Vazão Gástrica. Obteve-se sucesso. Resultados: Trinta e sete animais foram estudados em 60 intervenções no Laboratório de motilidade experimental. O projeto piloto “RGE:24h” foi abandonado após perda de 5 animais pela anestesia com halotano e, solucionada esta questão, a sistemática infecção do tecido celular subcutâneo nasal, dificultando a manutenção do cateter de phmetria em outros 5 animais. No “Projeto Piloto: Esofagostomia”, em cinco animais estudados (cada animal em duas ocasiões diferentes) não se reproduziram os achados de refluxo espontâneo. No terceiro projeto “Projeto Piloto: Gastrostomia” quatro animais foram estudados em dois momentos diferentes obtendo-se sucesso e reprodutibilidade XXIdos dados. Criado o modelo experimental, quatorze suínos foram submetidos ao experimento com implante endoscópico de PMMA com os seguintes resultados: A média dos pesos com 8 semanas de idade foi 14,98 ± 2,43 e 28 dias após o implante, 20,26 ± 3,68. O ganho ponderal foi considerado normal para a espécie. A Pressão de Vazão Gástrica média no dia 1 foi 8,08 mmHg e no dia 28, 10,69mmHg (Teste t de Student: t = 2,72 gl = 13 p = 0,017). Os Volumes de Vazão Gástricos médios foram: 392,86 ml para o dia 1 e 996,71 ml no dia 28 (teste t de Student: t = 11,66 gl = 13 p< 0,001). A Pressão Basal do EEI e o comprimento do esfíncter, não apresentaram diferenças estatisticamente significativas. PMMA foi identificado como depósitos de grandes vacúolos no tecido intersticial ao exame histológico da junção esofagogástrica associado a histiócitos, plasmócitos e presença de células gigantes tipo Langhans indicando reação tecidual de corpo estranho em todos os animais. Fibrose e macrófagos com vacúolos intracelulares estiveram presentes em menor freqüência. Conclusões: 1. O modelo experimental, em suínos, desenvolvido viabilizou o estudo do Refluxo Gastroesofágico através da Pressão de Vazão Gástrica e Volume de Vazão Gástrico; 2. O implante de PMMA, no presente estudo, aumentou a Pressão de Vazão e o Volume de Vazão Gástricos, mas não a Pressão Basal do EEI, nem tampouco aumentou o seu comprimento; 3. Depósito de PMMA implantado e evidência de processo inflamatório crônico e reação tecidual de corpo estranho foi encontrada no local do implante de PMMA. Macrófagos com vacúolos intracelulares e fibrose foram encontrados com menos freqüência.

Preliminary study on age- and sex-dependent alterations in the composition of skeletal muscle fibers of Brasileiro de Hipismo horses

The aim of this work was to characterize the distribution of myofibers in the gluteus medius muscle of inactive horses of the Brasileiro de Hipismo (BH) breed at different ages by means of histochemical analyses, according to sex and depth of the biopsy. A total of 78 inactive horses (9 castrated males, 35 stallions, and 34 females) of the BH breed, aged 1 to 4 years, were used. A percutaneous muscle biopsy was obtained with a 6.0-mm Bergstrom-type needle, which allowed the removal of muscle fragments at depths of 20 and 60 mm. Myofiber types were determined based on myofibrillar adenosine triphosphatase (mATPase) and nicotinamide dinucleotide tetrazolium reductase (NADH-TR) techniques. Morphometry of the fibers was determined based on cross-sectional area (CSA), mean frequency (F), and relative cross-sectional area (RCSA). The current study demonstrated that BH horses 3 and 4 years of age show a greater percentage of, and area occupied by, type IIA fibers and lower percentage of type IIX fibers in the gluteus medius muscle compared with horses 1 and 2 years of age. No difference was found between sexes in the frequency of and area occupied by the different fiber types at any of the depths and ages studied. In this study, females showed a greater CSA for all fibers in comparison with males, at 1 year of age. The results of the current study indicate that the gluteus medius muscle of inactive BH horses shows modifications in its structural and biochemical composition during the growth of the animals, leading to a better oxidative capacity.

CAROTID ARTERY EXTERIORIZATION IN BROWN BROCKET DEER (MAZAMA GOUAZOUBIRA) FOR AN EXPERIMENTAL STUDY of ANESTHESIA

This report evaluates the carotid artery exteriorization technique to allow repeated percutaneous artery catheterization in six brown brocket deer (Mazama gouazoubira). Repeated percutaneous catheterization of the carotid artery was possible for periods of 3 mo to obtain arterial blood and monitor arterial blood pressure of deer without risk of arterial rupture. The artery pulse was easily palpable for periods tip to 15 mo. Postoperative complication and/or arterial damage was not observed.

Light exercise causes adaptive changes in muscles of young Brasileiro de Hipismo horses

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeitos da eletroestimulação percutânea na incontinência urinária e qualidade de vida pós-prostatectomia: registro de seis casos

Introduction: Radical prostatectomy surgery is the best treatment currently adopted by detecting prostate cancer. The urinary incontinence is one more common and difficult to treat postoperative complications, which causes a negative impact on quality of life of the individual prostatectomy . The surface electrical nerve stimulation involves the transmission of electrical impulses from an external stimulator for peripheral nerve through surface electrodes attached to skin. It is an easy and efficient technique, widely used for pain relief, rehabilitation and muscle strengthening. Objective: To analyze the effect of T10-L2 percutaneous electrical stimulation, in individuals with urinary incontinence who underwent radical prostatectomy by the laparoscopic technique. Methods: Six patients had previously undergone radical prostatectomy were submitted to 20 sections of surface electrical stimulation with frequency of 4 Hz, pulse width of 1ms during 20 minutes. All subjects fillid a quality of life - International Consultation on Incontinence Questionnaire- Short FormI - ICIQ-SF questionnaire evaluating. Results: Results showed reduction in the use of the number of pads, number of leaks before and after treatment, and reduced voiding frequency and consequent improvement in quality of life. No side effects were reported. Conclusion: Percutanous electrical stimulation in T10-L2 may be an effective technique to treat urinary incontinence (UI) after radical prostatectomy video laparoscopy